HS Leads to Substantial Decline in Work Ability, Productivity

Hidradenitis suppurativa (HS) leads to a considerable decline in work ability and productivity and substantial loss of gross value added, according to the British Journal of Dermatology.

HS is a chronic inflammatory disease that affects intertriginous skin, and the disease burden has been previously described as debilitating.

A Woman is Uncomfortable

“Impairment dur­ing working hours correlates with disease severity, underlining the socioeconomic importance of early and adequate treatment. Furthermore, decreased work ability and productivity is linked to depressed mood and severe pain, aspects that need more attention in patient care,” said the researchers.

Researchers attempted to determine the extent of work ability and productivity weakness as a result of HS in Germany.

First, a prospective, multicenter, epidemiological, noninterventional study of patients of HS was conducted, and medical history, medical examination undertaken by dermatologists and patient-reported outcomes (Work Ability Index [WAI] and Work Productivity and Activity Impairment [WPAI]) were obtained.

Then, out of the 481 patients with HS included in the study, 99% were under the current statutory retirement age. A total of 53.3% of patients were working full time, 16.8% part time, and 7.3% had retired. The unemployment rate was 2 times higher than in the general German population, at a rate of 12.6%. Within the last 6 months, medical leave because of HS was reported in 41.4% (95% CI, 36.9­-46.0), with a length of 39.3 days on average (95% CI, 32.4-46.1). HS-related WPAI absenteeism mean was 13.3% (95% CI, 9.7-16.8), and the loss in productivity due to HS during working hours (WPAI presenteeism) was 25.2% (95% CI, 21.8-28.6). Presenteeism was linked with HS disease severity.

It was observed that general work impairment because of HS was 33.4% (95% CL, 29.3-37.6). The WAI score for patients was lower than the average German employee, at 32.2, ­–20%. Just 62.8% of patients were fairly certain that they would be able to perform their work in the next 2 years. Being more depressed and having more severe pain were linked with lower work ability and general work impairment. The estimated yearly loss of gross value added because of HS for Germany was about €12.6 billion (€3.3 billion related to a lower employment rate, €3.5 billion related to absenteeism and €5.8 billion related to presenteeism).

Surprisingly, there was no link between HS severity and the number of medical leave days.

The WAI score for patients with HS in this study was about 20% lower than the average German employee. Researchers found that it was especially important that the outlook on the future for patients with HS was fairly negative: about 40% of patients were not sure that they would be able to perform their kind of work for the next 2 years. WAI impairment also demonstrated a clear link with pain and depressed mood.

Patients were an average age of 25 years old when they first developed HS symptoms, aligned with previous reports. If the average estimated retirement age is 65 years, HS can influence an average of 40 years of working productivity. HS may impact different aspects of professional life, like employment, retirement, absenteeism, and presenteeism.

“The reported work productivity impairment of patients with HS leads to indirect socioeconomic-related costs, caused by a lower employment rate, absenteeism and reduction in work productivity. We estimated that these costs could be as high as €12 billion per year in Germany alone,” emphasized the researchers.

In the present study, 7.3% of patients with HS were retired in comparison to 4.3% in the German population, But, only about 10% of the retired patients with HS reported a premature retirement because of HS.

To the researchers’ knowledge, this is the world’s first assessment of the annual gross value added loss because of HS.

Besides the uncertainty about HS prevalence, a limitation of the study is the use of self-reporting questionnaires, and not every patient answered every question.

This study supports the development of new therapies that are needed to minimize the health-economic impact of HS.

Additionally, “a timelier improvement could be achieved by placing more attention on medical diagnosis and on care of depressed mood and pain, two aspects that play a role in the impairment of work ability and productivity,” concluded the researchers.

Reference

Schneider-Burrus S, Kalus S, Fritz B, Wolk K, Gomis-Kleindienst S, Sabat R. The impact of hidradenitis suppurativa on professional life. Br J Dermatol. 2023;188(1):122-130. doi:10.1093/bjd/ljac027